1.2.

2 Molecular Diagnostics of Other Sexually Transmitted

Bacteria
Although C. trachomatis and N. gonorrhoeae are the most frequently found sexually
transmitted bacterial diseases, in recent years other bacteria are also gaining
interest. Especially for Mycoplasma genitalium, it is becoming clear from transmission
studies involving bacterial typing (discussed later in this chapter) that these
bacteria are spread from one person to a sex partner. This bacterium is mostly
involved in non-gonococcal urethritis (painful or difficult urination) in men. In
women, it can also cause similar symptoms as well as infections of the cervix. Like
C. trachomatis and even more than N. gonorrhoeae, M. genitalium is difficult to
culture. It requires inoculation in tissue cultures and even then can take weeks to
grow. Using molecular diagnostics is therefore the only realistic means of detection.
In contrast to C. trachomatis and N. gonorrhoeae, there are hardly any validated
commercial assays available for M. genitalium and there is no consensus on who
should be screened or tested for this pathogen. Nonetheless, recent reports investigating
the prevalence of M. genitalium have shown increasing rates. In Denmark,
a nationwide survey in a risk-population showed detection rates of up to 4% in
woman and up to 10% in men. More importantly, antibiotic resistance seems highly
common, with 40% of the positive samples in the Danish study being resistant to
macrolide antibiotics (a common treatment for non-gonococcal urethritis). Due to
difficulties in culturing of this bacterium, assessment of antibiotic resistance has to
occur through molecular diagnostics. However, this is currently only performed in
highly specialised laboratories.
Finally, other bacteria that are potentially involved in sexually transmitted
infections are increasingly being investigated by molecular diagnostics. Similar to
the situation with Mycoplasma genitalium, for Ureaplasma urealyticum, which also
causes urethritis, there are hardly any commercial assays available and non-routine
diagnosis is performed with in-house PCR protocols. There is growing evidence
that imbalance in the vaginal microbiota increases susceptibility to different sexually
transmitted infections. There are different molecular methods available (such as
next generation sequencing and quantitative PCR algorithms) that are used to
investigate changes in the vaginal microbiota.
1.3 Molecular Diagnostics of Bacterial Gastroenteritis
The second example discussed in this chapter regards bacterial gastroenteritis,
which remains an enormous global health problem. The burden of disease is most
critical in developing countries, especially among children under 5 years of age. It
is also an important cause of morbidity and is associated with significant health-care
costs in high-income countries. Here, bacterial gastroenteritis in usually
self-limiting and, most of the time, neither empirical antimicrobial therapy nor
laboratory diagnostics are needed. Prevention of transmission is the most important
measure, especially in patients with acute diarrhoea. In contrast, identification of an
etiological agent is required for management of patients with severe diarrhoea, for
those showing symptoms that are consistent with invasive disease or with complications.
In this case, clinical diagnosis guides clinicians in making the decision to
start appropriate therapy as early as possible. Besides the value for individual
patient care, characterization of bacterial enteropathogens is also necessary for
hospitals to implement correct infection control measures and for public health
officials to identify and track outbreaks of bacterial gastroenteritis.